We present a 39-year-old G0P0 with history of infertility treatment-caused ovarian hyperstimulation and uterine fibroids, who was found to have a rare pathological presentation. Peritoneal lesions were identified during laparoscopic treatment for this patient's fibroids. Histological evaluation of these lesions revealed leiomyomatosis peritonealis disseminata (LPD), also known as disseminated peritoneal leiomyomatosis. While LPD can often be confused for metastatic leiomyosarcoma due to the histological presence of fibroblasts, myofibroblasts, smooth muscle, collagen, and spindle cell appearance, cases of LPD are generally benign, and present no need for therapy in asymptomatic cases. We present a discussion based on the clinical and sonographic presentation of LPD, its pathophysiology, treatment options and prognosis. A question set has been designed to reinforce comprehension of this presentation and associated topics for health care professionals.
Uterine bleeding is a symptom seen by gynecologists in approximately 70% of their visits with women of peri and postmenopausal age. A common symptom, postmenopausal bleeding sometimes can be indicative of malignant pathology. While traditional diagnosis took place via endometrial biopsy, diagnosis is trending toward the use of ultrasound. Benefits of ultrasound include its noninvasive nature, decreased cost, and increased accuracy in diagnosis of postmenopausal bleeding. We present a case-based approach to the usage of various ultrasonography techniques including 2D and color Doppler ultrasound, saline infusion sonography (SIS), 3D and 3D power Doppler ultrasound, as complements to traditional diagnosis of endometrial biopsy. In each of the cases, ultrasonography reveals the diagnosis of postmenopausal pathologies, including atrophic endometrium, endometrial polyps, endometrial hyperplasia, and the malignant pathology, such as endometrial carcinoma, uterine leiomyosarcoma and cervical carcinoma. By the end of our case-based discussion, learners are encouraged to test their knowledge in self-assessment quiz.
New technology in ultrasound imaging is allowing women to view more visually precise images of their fetuses than ever before. Maternal-fetal bonding describes the attachment interaction that forms between a mother and her unborn child. Ultrasound diagnosis modalities including two-dimensional (2D), three-dimensional (3D) and four-dimensional (4D) may create differences in the amount of maternal-fetal bonding, depending on the modality used. When relevant literature was reviewed on this topic, no significant difference between maternal-fetal bonding was found when comparing 2D vs 3D vs 4D ultrasound. However, certain measures such as a perceived feeling of closeness to the baby were higher with 3D and 4D ultrasounds as compared with 2D ultrasound. Further exploration is needed to ascertain whether different ultrasound modalities have an effect on maternal-fetal bonding in multigestational pregnancies, pregnancies in which there is fetal demise, and to overall examine the effects of using ultrasound for nonmedical 'entertainment' purposes by prospective mothers.
Gestational diabetes mellitus (GDM) is defined as glucose intolerance that begins or is first recognized during pregnancy. Numerous clinical factors are associated with an increased likelihood of GDM, such as increasing age, obesity, ethnicity, family history of diabetes and past obstetric history. There is a well-documented relationship between maternal hyperglycemia and increased rate of macrosomia, cesarean section, stillbirth, fetal congenital malformations, shoulder dystocia, hypoglycemia, hyperbilirubinemia, pre-eclampsia, preterm delivery, childhood obesity, and increased risk of maternal development of type 2 DM later on in her life. This case-based review is designed to provide health care workers a framework on using various ultrasound imaging modalities in early detection of the effects of gestational diabetes, and the specific conditions and/or anomalies seen in diabetic pregnancies.
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